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How Do you Know When You're On Enough B12?

Sparklingsunshine profile image
β€’40 Replies

I'm normally on the thyroid forum but have posted on here a few times and I would value your expertise. Sorry for the magnum opus post 😁

I've been on B12 injections for a number of years, used to be every 13 weeks but as I have other conditions, Fibro, Ehlers Danlos and hypothyroid and I've had persistent muscle twitching and pins and needles in my hands and feet all the time for years, I managed to beat my surgery down to a jab every 8 weeks. I've been on these for about 18 months.

I've never received an explanation for my parathesia but as anyone with Fibro can attest everything gets blamed on that, and as I have several conditions where there is alot of symptom overlap, it can be impossible to differentiate between them.

Whenever I've had my B12 blood levels tested by NHS they are really high, I know its pointless doing them but the GP always orders them when they are doing other tests like FBC. Just shows they dont read our records lol.

I think mine are often significantly over range. The reason I ask is I started having weird balance issues 2 years ago. Its been put down to vestibular migraine, I've seen a Neuro and ENT specialist but I dont fit the criteria and no anti migraine meds have worked and I've tried at least 6. I've tried vestibular physiotherapy, pretty much anything I can think of including seeing a chiropractor. I stopped the latest migraine in January and I'm no worse not being on it.

I'm not dizzy but unbalanced when I walk. Its not terrible and has improved since 2022 but its still a constant sensation. Rather like walking on a trampoline or a spongy floor. I'm aware of the connection between low B12 and neurological issues, but is it possible that with my high B12 blood levels that I'm not getting enough B12 into my cells, ie functional B12 deficiency and is there any test I could take to prove it?

Just for the record I'm a lifelong vegetarian and have struggled with low B12 all my life. Only started on jabs about 10 years ago. I'm wondering if its caused permanent damage. Your input would be much appreciated. I'm still seeking answers and dont want to keep going down rabbit holes.

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wedgewood profile image
wedgewood

When whatever regularity of injection you are on has eliminated your B12 symptoms.

Sparklingsunshine profile image
Sparklingsunshineβ€’ in reply towedgewood

Unfortunately I have several overlapping conditions that mean I can't tell which one is causing which. I didnt know if its worth trying the active B12 test?

wedgewood profile image
wedgewoodβ€’ in reply toSparklingsunshine

I see . Yes , I would say it is worth it when a had b12 blood serum test and an active b12 test within 2 days of eachother, the blood serum test was right off above the scale. The active B12 reading was just over 1/2 the full range . But it will still be tricky because optimum levels differ from patient to patient . And anyhow , it can take a few years of injecting to clear symptoms , as we read in patients accounts on this forum. It is indeed difficult for you to judge if you have different conditions with the same symptoms as eachother .

Wheat profile image
Wheat

hello sparklingsunshine, I used to get the spongy floor sensations regularly at the time i only knew i had M.E., which I attributed it to.

The nhs test is as you say pointless, you would have to privately do Active B12 blood test to find out real, cellular level B12. I used medichecks recently but many more labs online. Thyroid uk has several listed.

Eight week injections may be insufficient to effect healing. Have you considered self (or willing person) injecting more frequently , to see how that helps.

Best wishes x

Sparklingsunshine profile image
Sparklingsunshineβ€’ in reply toWheat

Frankly I'd consider murder or sacrificing a goat to Lucifer at this pojnt lol. I'm certainly not averse to self help. I source T3 for my thyroid and get Low Dose Naltrexone for my Fibro privately prescribed.

I've tried so many things over the last two years, as I said its hard when you have several conditions to know which one is the culprit. All I know is I feel pretty rubbish and I'd like to know what the cause is. Basically two years ago this month I had a migraine, which had been happening more and more frequently, the day after the migraine I started experiencing the spongy floor sensation, which has never gone away.

I've had brain MRI and nerve conduction studies which were normal so no MS or other Neurological cause was found. So was told Vestibular Migraine but I've never bought that. VM has very specific criteria, which I dont meet. I dont understand how you can just lose your balance overnight unless its something like a tumour or stroke.

I've been down a lot of rabbit holes over the last two years and because my NHS B12 results on blood tests were always so high I guess I dismissed the possibility that it could be that but I'm willing to consider anything at this point. Any advice on self injecting gratefully received.

Mixteca profile image
Mixtecaβ€’ in reply toSparklingsunshine

I literally lost my sense of balance over the space of a few hours one afternoon.

It started off with dizziness, which I initially put down to being hungry or low blood sugar, but by the evening I felt as if I were on a merry-go-round and the room was spinning - it was very frightening. I was taken to my sister's house nearby but the driver had to stop several times as the motion of the car made me vomit.

Long story short, I promptly saw a specialist who did tests and I was diagnosed with vestibular neuronitis and given head exercises to do. No cause was identified but the exercise programme did the trick and I slowly regained my balance.

Sparklingsunshine profile image
Sparklingsunshineβ€’ in reply toMixteca

I never had vertigo or spinning, I was tested for BPPV, the most common cause of dizziness. Mine literally came over night following a migraine, but I had no virus, no ear infection or any precipitating event. Mine was just feeling off balance all the time when standing or walking. And unfortunately the vestibular rehab exercises haven't helped me πŸ˜’

Mixteca profile image
Mixtecaβ€’ in reply toSparklingsunshine

My specialist said the issue was in my inner ear but it wasn't preceded by illness, an infection or a virus. I had to do them continually without a break and build up gradually, twice a day in order to regain my sense of balance. Started with about 10 mins and by the end, 6 months later, I was spending 3 hours doing them each time. I can't remember the name of the tests I had but they didn't involve imaging. I think I had an electronystagmography and and audiology test.

Sparklingsunshine profile image
Sparklingsunshineβ€’ in reply toMixteca

I saw under the care of a vestibular physio and we tried the exercises but even she said she didnt think they would help in my case. Mine seems to be neck related rather than vestibular.

Mixteca profile image
Mixtecaβ€’ in reply toSparklingsunshine

The key thing seems to be a lack of a diagnosis and possibly the wrong tests.

Sparklingsunshine profile image
Sparklingsunshineβ€’ in reply toMixteca

No disagreement there πŸ˜‰

Mixteca profile image
Mixtecaβ€’ in reply toSparklingsunshine

A very familiar story! In the NHS at least. Thankfully I was living in Mexico at the time and finding the right specialist was easy. Worth every peso I paid.

Sparklingsunshine profile image
Sparklingsunshineβ€’ in reply toWheat

Did you find self injecting helped with your balance issues?

Wheat profile image
Wheat

yes, I am so pleased overall. s.i. 3 times a day, sometimes 4. Nearly a year now.

I have balance problems and eyesight problems that adversely affect balance. I used to fall over frequently. Stumble and overbalance and fall into walls, doors, chairs. many times a day etc.

First I noticed my grip was stronger. I felt stronger.

Maybe a couple of months ago I noticed my core or balance was better. If i lost my balance I was able to right myself. No falling down, fingers crossed. I do not know if this will last. I hope so.

x

Nackapan profile image
Nackapan

Sometimes we are left with symptoms however much b12 we inject .I'm left with s vestibular disturbance. Had 2 brain MRIs a yesr apart.

Awful migraines.

Some were vestibular migraines.

Then told I've always got one in the background that spikes now and again.

My daughter has EDS abd POTS and had megobolastic anaemia and severe b12 and folate and ferritin deficiency.

She had a misdiagnosis of fibromyalgia.

She's on 10 weekly b12 Injectiibs and daily folic acid.

Have you tried high dose b12 sprays and b12 tablets inbetween your injections?

Or have you PA ?

The only way to tell is if you trial a higher frequency of b12 Injections.

Kerp a diary

Is your folic acid, ferritin, and vit D okay ?

Try vestibular pysio again.

I had to revisit it, although the earlier sessions got me walking it then triggered migraines.

A year later I could so more .

I'm still improving 5 years in.

I also had ear pressure tests following a long awaited ENT appointment by phone!!

My hearing and pressures are fine .

As is my health of my eyes.

Csn only think nerve damage ,messaging gone wrong.

Hooe you finds ways to improve.

Ruling things ouf like meniers ect

It's definitely management for my daughter and myself.

Improvements do continue.

Sparklingsunshine profile image
Sparklingsunshineβ€’ in reply toNackapan

I use sublingual drops in between jabs and all my vitamins are good as I supplement all the time. My vestibular physio suspects I have cervical spine instability in my neck due to EDS as I get a lot of pressure at the back of my skull.

Nackapan profile image
Nackapanβ€’ in reply toSparklingsunshine

That's horrid . I got alot of head pressure .I had my neck included on the second mri.

Nothing seen.

Tey more b12 injections and sed if if helps

Sparklingsunshine profile image
Sparklingsunshineβ€’ in reply toNackapan

Its really hard to play detective, I've given up on NHS tbh and am left trying to work out what's going on. As they've ruled out anything life threatening and told me its vestibular migraine as far as the NHS is concerned that's it.

Me having Ehlers Danlos is another complication as due to lax ligaments and joints I'm prone to clumsiness and balance issues from that. Although I've had it over 50 years as its genetic and never had clumsiness or balance issues before.

Feels like another cop out. I'm used to chronic health problems but I'll admit this one has been the worst. Its really affected my quality of life.

Nackapan profile image
Nackapanβ€’ in reply toSparklingsunshine

My daughter to date has not had balance issues due to her Ehlers Danlos HEDs.Has had hip joints out of place.

Special cutlery for eating .

Her blood vessels hypermobile / too lax so severe digestive issues a very restricted diet helps.

Fibromyalgia was a mis diagnosis for the pain she wax having.

Pots causes low blood pressure on standing . Dizziness and collapses.

Fit like episodes were frequent.

Now on a steroid

Last resort but changed her life

The condition that is worse for her.

She has had vertigo in the past .

As you say it's elimination.

Then self-help.

My daughter has had so many years trying to get some life.

The B12 deficiency was the root cause .

I've nothing else going on to date .

Only thing muddying the waters for me is had an awful fall banging my head hard on concrete .

But the undiagnosed b12 deficiency was the cause of the falls!!

Late diagnosis very low b12 .

My vertigo/ balance was sudden too.

Clumsiness/ foot drop for quite a long time getting worse

As you've mentioned.

I thought i was having a stroke as the finale

Head CT

Mris clear .

Only on B12

Sleepybunny profile image
Sleepybunny

Hi,

Apologies for quick reply.

I have an arm injury so at moment have to limit my typing.

MMA, homocysteine and Active B12 (holotranscobalamin) tests may help to diagnose functional B12 deficiency.

More info in these threads

Help Needed! Have I got Pernicious Anaemia?

healthunlocked.com/pasoc/po...

Patient Safety, useful links for UK forum members having difficult health experiences with B12 deficiency

healthunlocked.com/pasoc/po...

More info in pinned forum posts.

Sparklingsunshine profile image
Sparklingsunshineβ€’ in reply toSleepybunny

I've been looking at getting an active B12 test privately. The homocysteine and MMA ones are presumably NHS tests? Sorry about your arm, hope its on the mend.

I dont know how I feel about approaching GP. The ones I've seen assume everything must be peachy once on jabs and as my NHS B12 tests are usually very high I'm scared they'll take my jabs away. Plus as I have Fibro they blame everything on that πŸ˜’

We see this so so often on the thyroid forum and I'm sure PA/ B12 deficiency is just as badly treated. I've been ok, apart from the battle to get jabs every 2 months not 3 but I'm very aware of the number of sufferers being put back on tablets, having jabs withdrawn. I'm wary of poking the bear.

Sleepybunny profile image
Sleepybunnyβ€’ in reply toSparklingsunshine

Hi,

I think you would need referral to a specialist eg haematologist to get Homocysteine and MMA tests on NHS.

It's possible but expensive to get them privately in UK.

"my NHS B12 tests are usually very high I'm scared they'll take my jabs away. "

Many of us live with that fear.

There's a lot of ignorance about B12 deficiency and PA among health professionals.

B12info.com blog post

Your serum B12 is NORMAL – no action required.

b12info.com/your-serum-b12-...

Help for GPs

1) PAS website has a page for health professionals.

Your GP could join PAS as an affililiate member, no charge.

pernicious-anaemia-society....

2) Has your GP heard of Club B12?

club-12.org/

Club B12 is a group of researchers and health professionals who are looking into B12.

They have regular zoom meetings and have hosted a conference in UK.

3) Useful articles to pass to GP

From Mayo Clinic, US

pubmed.ncbi.nlm.nih.gov/311...

The Many Faces of Cobalamin (Vitamin B12) Deficiency

Bruce H R Wolffenbuttel 1, Hanneke J C M Wouters 1 2, M Rebecca Heiner-Fokkema 3, Melanie M van der Klauw 1

Affiliations expand

PMID: 31193945 PMCID: PMC6543499 DOI: 10.1016/j.mayocpiqo.2019.03.002

Free PMC article

Recent BMJ article about B12 deficiency by B. Wolffenbuttel

In my personal opinion, he's one of the few doctors who understand B12 deficiency.

bmj.com/content/383/bmj-202...

Vitamin B12

BMJ 2023; 383 doi: doi.org/10.1136/bmj-2022-07... (Published 20 November 2023)

Cite this as: BMJ 2023;383:e071725

The author of above also wrote an article for PAS in Jan 2024.

Only One Chance

pernicious-anaemia-society....

Cornwaller profile image
Cornwaller

A trial of more frequent b12 injections would establish if it yielded a benefit for you. Realistically this would require self injection. Fortunately the lovely people on this site can provide support if you require it.

I hope you find relief of your symptoms.

Wwwdot profile image
Wwwdot

Hi Sparklingsunshire

I do understand the sensation you describe and it’s unsettling. I have PA so cannot absorb B12 that’s how my B12 got so low.

I have been self injecting for a year now and I can keep all symptoms at bay apart for lower back pain which still comes and goes .

As you are vegetarian you could try high doses of oral B12 (British supplements are good) and see how this goes but ideally you need to know what your folate, iron and potassium levels are too as they all work together and your recovery may be limited otherwise by a deficiency in something other than B12. I take a 400ug folic acid each day to keep levels topped up.

The good thing is that you cannot overdose on B12 so that’s something you don’t need to worry about. It may be worth trialing high dose oral supplementation for a couple of months and keep good symptom notes.

You may have a pleasant outcome!

All the best

πŸ€—πŸ€—πŸ€—

MarvelDC profile image
MarvelDC

Have you had other blood tests done to check for other things?? Alot of your symptoms you describe could also be caused by low iron!!

You’ve been on b12 a while so there could be other causes, alot of people with b12 issues also have iron issues, and iron levels can naturally drop when you have b12 injections, since the b12 needs iron to build new red blood cells and help heal the body.

Have you had an iron panel done recently??

Sparklingsunshine profile image
Sparklingsunshineβ€’ in reply toMarvelDC

Yes 18 months ago it was tested by NHS and was all good, which surprised me as I've always struggled with low iron. Guessing being post menopause has helped 😁

Mixteca profile image
Mixtecaβ€’ in reply toSparklingsunshine

That is too long ago, you need to have ferritin checked regularly, possibly every 6 months, especially if you've had low iron in the past and are having B12 injections. Things can shift much more quickly but GPs won't realise this. My iron levels dropped fairly quickly in the first 3 or 4 months of EOD B12 treatment.

Sparklingsunshine profile image
Sparklingsunshineβ€’ in reply toMixteca

My bloods were tested in hospital at the end of February this year when I had to go in with an asthma exacerbation. Nothing was flagged up. Since being post menopause my iron levels have behaved themselves.

Cherylclaire profile image
CherylclaireForum Support

The spongy underfoot feeling sounds like numbness in soles of the feet due to nerve damage - although I'm not medically trained.

Neurological symptoms with B12 deficiency should be treated with every other day B12 injections until no more improvement can be gained by this, and only then maintaining this with treatment every 2 months. This is medical guidance given to UK doctors regarding treatment. Even with this frequency of injections, nerve damage can take a very long time to repair. Sometimes some of the damage can be permanent - but I wouldn't assume this is the case, however severe or long-term.

B12 deficiency nerve damage can be due to demyelination of the spinal nerve bundle. This damage should be able to be detected by a neurologist via an MRI scan. Other damage can be detected by electric nerve testing (of large nerves: legs and arms) and even smaller nerves can be tested, but rarely are. Definitely neurologist's field.

It is also possible that you have functional B12 deficiency. If the problem is that your serum B12 is high and your serum MMA is high, these two are perhaps not forming links in the bloodstream in order for sufficient B12 to be transported to where it is needed at cell/tissue level. A serum MMA test would be able to rule this in or out as a possibility.

My MMA was tested on GP request when my B12 injections, given for B12 deficiency, did nothing to alleviate symptoms. It was raised. This gave me a confirmed functional B12 deficiency diagnosis and a restart of injections at 2 per week. Despite this frequency, it still took three years for my MMA to drop into range. This was tested in all 6 times, mainly by haematologists.

I now self inject twice a week which mainly controls my symptoms. They are not gone - this is symptom control not cure.

My active B12 was tested and was (unsurprisingly) high, my homocysteine was normal, my DNA gave no answers regarding MMA - but I was found to have osteoporosis of the spine so get vitamin D and Raloxifene daily, and my ferritin and folate can still be difficult to stabilise at healthy levels no matter how healthily I eat. Supplementing can be difficult without regular monitoring, as you can't guess at your highs and lows, can you ? My brain MRI, much to my surprise, was normal.

You are coping with a lot of health conditions and disentangling symptoms can be very difficult, I'd imagine. I hope at least some of this helps. The ideal would be to have a really good supportive GP who can help, observe, monitor and refer- and then some continuity. Also difficult now.

Sparklingsunshine profile image
Sparklingsunshineβ€’ in reply toCherylclaire

I've had nerve conduction studies which were all normal. Yeah I'd love a supportive GP but have never found one. My experience of chronic conditions is once diagnosed you are "parked"by the NHS and left to get on with it.

I have wondered about peripheral neuropathy in my feet but as my nerve conduction studies, which I've now had twice were all normal I dont think they'll consider it. I did wonder about small fibre neuropathy as well. I'm wondering whether to push this with a GP or not? I dont want to lose my jabs lol.

Cherylclaire profile image
CherylclaireForum Supportβ€’ in reply toSparklingsunshine

I do remember someone on this forum mentioning they have had that done. Painful, but damage was found that was not discovered in larger nerves. A while back now.

Perhaps one to ask for when you next see a GP for something else- and find them in an approachable mood ?

I did have an excellent GP, but she left to work for a local hospital. Two others from the same surgery did the same thing. I think the best of them were as utterly disheartened with the introduction of compulsory telephone appointments as we were.

False economy seems to be a post-Covid trend.

Sparklingsunshine profile image
Sparklingsunshineβ€’ in reply toCherylclaire

Yes my previously excellent GP retired after covid, I'd seen her for decades. She had enough of telephone calls, said she felt like a call centre worker, not a doctor.

She missed seeing patients face to face. Its was a real shame. I rarely see GP if I can help it lol. As you might have inferred they aren't my favourite people. I just dont have any faith in their ability to manage chronic conditions.

Cherylclaire profile image
CherylclaireForum Supportβ€’ in reply toSparklingsunshine

Don't feel like doing this all over again with a new GP, either. So no-one monitoring now.

Alpaca24 profile image
Alpaca24

Hello,

I had exactly the same spongey feeling you describe that started shortly after B12 injections. My understanding is that the B12 deficiency exacerbated pre-existing migraine that I had. This symptom is commonly part of vestibular migraine. I resorted to self-injecting B12 every 10 days and got help from a neurootologist for the vestibular migraine. Also see mvertigo.org website for more info on this). I take medication for migraine and made diet changes that have really helped! It did take a while to calm down though. Stress also really seems to exacerbate it. Of course it may not be the same but I hope some of this is helpful info for you.

Sparklingsunshine profile image
Sparklingsunshineβ€’ in reply toAlpaca24

Yes I joined M.vertigo. None of the 6 or 7 anti migraine meds worked for me, I took Venlafaxine for 11 months as a lot of members said how good it was. It make no difference so I came off it and in the 4 months since I did no migraines, no other VM symptoms.

It seems to me that both the Neuro and ENT took the fact I got classic, ie non VM migraines and was suddenly unbalanced and made 5.

I've never bought it and the fact that no migraine meds have helped and I've tried beta blockers, calcium channel blockers and several anti depressants and absolutely nothing has helped with the balance, which is my only real symptom, leads me to think something else is responsible. I have no migraine symptoms anymore, just this weird off balance sensation.

Alpaca24 profile image
Alpaca24β€’ in reply toSparklingsunshine

Ah yeah sounds like it’s unlikely to be migraine related then. Definitely worth increasing your B12 injection frequency to see if it helps. Hope you find a solution!

phoebegrant profile image
phoebegrant

Amongst the other blood test results, what was your folate reading (and lab range)? Sufficient folate is required to move the B12 into the cells where it's needed. It is usually recommended that the folate should be in the top quarter of the lab range.

sezzp profile image
sezzp

Have you tried betahistine for the balance issues? They say that I have vestibular migraine, as I don't have significant hearing loss but beta histine works for me, suggesting it's more likely Menieres disease. I've temporarily stopped the b12, as I felt so awful taking it and, like you, my bloods were off the scale. I plan to test again at the 4 month mark, so see if it was just a diet thing for me.

Also, I developed the most horrible anxiety while reversing out, which was something I never had before. I was suicidal, so I chose the easy option and stopped the SI. I also realised all my symptoms were worse before and during my period. This included the peripheral neuropathy. Long story short, I'm a month into HRT and have 'mostly felt more like myself than I have in years. It appears that it has been more a low oestrogen thing for me. Only issue is, as soon as I started the progestogen side of the hrt the symptoms returned within 24 hours. Anxiety and pins, needles and tremors were back. I'm now about to try a different brand. Just praying I don't have the same reaction to it!

Sparklingsunshine profile image
Sparklingsunshineβ€’ in reply tosezzp

Actually Betahistine was the first med I tried, after Stemetil. Didnt help and the ENT said no Meniere's disease was found.

Nackapan profile image
Nackapan

Thats very intertesting about betahistine helping you.Hope thd HRT helps you .

I trialled HRT patches. Post menopausal.

I glad? 4 days of more energy then chaos.

The g.p had s gynaecology background.

She 2as really trying to help me.

Unfortunately it thought I was too old to benefit hence the chaotic emotions then hideous migraine .

Too much of s shock tk my system

Hopefully you ate starting young enough to benefit.

It wax the menopause and dramatic hormone changes that gave me the severe b12 deficiency in the first place

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